|Pain Level After Surgery
|Duration of Surgery
|Around the areola, lollipop, or anchor incision
|Return to regular activity
If a woman desires bigger breasts and feels that her breasts are sagging, then she may be a candidate for a breast lift and augmentation. Depending on the degree of lift desired, skin will have to be removed from the breast to achieve the lift. Although a lift will reposition the breast to a more elevated and youthful position, nevertheless, the breast may lose about 10%-15% of its volume because of skin removal. In this situation, you have a choice to try on implants and see whether you would like an implant to be done at the same time as the lift, or have the procedures done separately. An augmentation/ lift procedure is a more involved procedure than either a lift or an augmentation alone. It also carries a higher risk of complications, but it is usually an extremely satisfying surgery.
Very rarely are a woman’s breasts perfectly even, or symmetric. Sometimes, the lack of symmetry can cause a woman to be distressed, adding prosthetic implants in her bra to achieve symmetry. This is a common situation that women do not like to discuss. The solution is straight-forward. If a woman with uneven breasts seeks a breast augmentation, it is simple to fill one breast implant more than the other to make the breasts as symmetric as possible. Sometimes a breast augmentation is performed on one breast and a breast augmentation and lift, or a breast lift alone, or even a breast reduction is performed on the opposite breast simultaneously. The treatment plan is agreed upon during the consultation.
If a woman desires bigger breasts and feels that her breasts are sagging, then she may be a candidate for a breast lift and augmentation. This is commonly seen when the breasts become deflated after pregnancy or significant weight loss. Breast lift with augmentation allows for complete correction of the breast. The excess skin is removed to elevate sagging breasts and reposition dropping nipples. The size and fullness of the breasts are enhanced to improve the size and cleavage.
There are many different ways of doing a breast implant and lift procedure. Our preferred approach is placing the implant through an armpit incision, and then performing the breast lift. The advantages are as follows:
“I am so happy with my breast implants, I would do the procedure all over again in a heartbeat.”
Our next most commonly used approach is to combine the breast lift and breast augmentation through an inframammary approach or through the mastopexy incision. The advantages to this approach are as follows:
An initial consultation is set-up where we will discuss the breast lift with augmentation procedure and to decide whether you are a good candidate for the surgery. At this stage we will also have an additional discussion regarding selection of your implants. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
We perform a breast augmentation/lift procedure by combining both a breast augmentation procedure and a breast lift procedure. First we perform the breast augmentation from an under-arm approach or through the mastopexy incision site/inframammary. The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this operation, is taken to the operating room. They are given antibiotics, and anesthetized. The breasts are injected with tumescent solution to give some pain relief and decrease the bleeding during surgery. A pocket is created behind the muscle. An implant sizer – think of it as a disposable implant- is placed in the pocket and inflated to the volume desired by the patient. The patient is sat up in the operating room and the breasts are inspected. When a very nice result is achieved, the patient has the sizer removed and the true implant placed in the correct location.
Next we perform a breast lift. The breast lift technique depends on the amount of lifting needed:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center, with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after breast lift with augmentation can be traumatic to a patient. It usually happens in the hours following the procedure, and usually happens on one side. Sometimes, a small amount of bleeding can be observed, but if the bleeding becomes significant, then the patient needs to have the blood removed in the operating room in a usually straight-forward procedure. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. We use tumescent solution, similar to that used in liposuction, before starting a breast augmentation procedure to decrease the amount of bleeding. That technique plus minimal dissection, handling of the muscle during the procedure and creating the appropriate pocket size for the implant are all techniques that decrease the chances of post-operative bleeding. In our practice the rate of hematomas in breast augmentation/lift is less than 1%.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the actual surgery. During the surgery, the skin surface of the patient is cleaned properly. Next, the doctor changes gloves multiple times during the operation, and he is the only one who handles the implant in the operating room to ensure total sterility and avoidance of infection. After the procedure, our patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, our implant infection rate is significantly lower than the national average at less than 1%.
Wound healing problems can occur at the superficial incision level where the tension is highest, and a small open wound may occur which will usually heal nicely with dressing changes and antibiotic ointment. The scar usually heals very well. Very rarely, we will do a scar revision to improve the appearance of that scar.
Capsular contracture is the hardening of the scar tissue around the implant and occurs in 10%-15% of women with breast implants. It can also be a factor of time elapsed since the implant placement. Every implant will have scar tissue around it; that is totally natural. What is undesirable is for the scar tissue to harden and cause the patient pain or unnaturally-looking breasts. The theories behind the cause of capsular contractures vary. Capsular contractures may be caused by a sub-clinical infection, by significant bleeding during the operation, or by time alone. In the previous section, we discussed how to minimize the risk of infection and bleeding. As a result, our rate of capsular contracture has been less than 1%.
Rippling is the formation of small waves or folds of the breast surface due to a breast implant. Sometimes rippling is visible, other times it is palpable, or both. In the case of breast augmentations, especially with saline implants, this potential result can lead to patient dissatisfaction in up to 10% of breast augmentation patients. In order to avoid rippling, one must understand what causes it. The chest muscle, or pectoralis major, does not cover the chest totally; the lateral edge of the breast is not covered by that muscle, which is used as coverage for a breast implant. Rippling can be avoided or minimized by giving the breast implant maximum coverage with breast tissue and muscle. For that specific reason, rippling is minimized by placing an implant under the pectoralis major muscle and by selecting an implant size that would be covered almost completely by the muscle. As a result, the implant cannot be felt from the lateral edge of the breast. Because of these two guidelines, the rate of rippling among our patients is less than 2%.
Deflation or Rupture
Breast implants are devices. Their lifespan of “looking good” varies between different types, the patient’s conditions, and the technique used, but that lifetime is not indefinite. The younger the age of a woman seeking breast implants, the higher the probability that they may have to be adjusted or replaced at some point in the future. The good news is that newer breast implants are made of better material than the old ones and have a longer lifespan, with fewer complications. It is difficult to quote rates of breast implant rupture or deflation because it is a function of time. The best way to minimize this risk is by paying attention to each step in the pre-operative evaluation of a patient, the actual surgical procedure, and the follow-up care. If an implant ruptures or deflates, it needs to be exchanged. Saline implants ruptures are easier to diagnose, but silicone implant ruptures may need MRI imaging to make that diagnosis.
Ability to Breastfeed
Women are sometimes concerned that if they get a breast lift with augmentation, they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed is very small. With breast lift with augmentation, inability to breastfeed has not occurred with any of our patients to our knowledge.
Loss of Nipple Sensation or Nipple / Areolar skin
Loss of nipple sensation is a potential complication from breast lift with augmentation. It is rare with a less than 1% occurrence. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks. There is theoretically a higher chance of losing the nipple in a breast lift with augmentation procedure than in either a lift or an augmentation alone due to changes in blood supply to the nipple. A conservative skin removal is performed to decrease the chance of injuring the blood supply and prevent undue tension, which leads to wound healing problems.
Smoking is an absolute contraindication in breast lift with augmentation. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, loss of nipple tissue, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.
To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.
At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.
There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.
We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.
We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.
Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.
For more information, call our office at 703-206-0506.
Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.
If you would like further information regarding this procedure, please feel free to contact our office to schedule an appointment by calling (703) 206-0506 or filling out an online request form.